Pacific Coast Society of Orthodontists Bulletin Spring 2020 - 29

Clinical Practice

Let's Talk About That

Dr. Patrick Turley Interviews
Drs. Larry and Will Andrews
Patrick Turley (PT): The two of you have developed a comprehensive approach to orthodontics
over the years. Can you give us a brief overview of
your philosophy?

Dr. Patrick Turley
PCSO Bulletin Section Editor
Manhattan Beach, CA

Will Andrews (WA): Pat, it's a pleasure to share
some of our ideas with you and the PCSO Bulletin
readers. We use the term orthodontic philosophy
to imply a comprehensive framework of knowledge within which reasoned decisions can be
made. The subjects within a philosophy include,
among other things, records, goals, diagnosis,
classification, concepts (including growth and
growth modification), precepts, policies, strategies, and materials (including appliances)-pretty
much everything you would need to know to
effectively evaluate and treat almost any patient.
We recently finished writing a comprehensive
new textbook titled The Six Elements Orthodontic
Philosophy™, which will be released in 2020. The
textbook will explain and illustrate all aspects of
the philosophy in full detail. Perhaps the most
important component involves treatment goals,
which differ substantially from conventional
orthodontic goals.
PT: What are some of these treatment goals?
WA: There are six major areas of the orofacial
complex for which we are responsible. Each
area has its own goal or set of goals, collectively
known as The Six Elements of Orofacial Harmony™. On a very basic level, we orthodontists are
responsible for moving the teeth and jaws. We
would like for these new positions to at least
maintain and hopefully to enhance the health,
function, and appearance of the patient to the
greatest extent possible. Consideration is given
to dental, periodontal, temporomandibular joint,
and airway health as well as masticatory function
and facial appearance.
In brief, the goals include the six keys to optimal
occlusion1 with the mandible in centric relation,
the roots of the teeth in well-defined positions
relative to supporting tissues, optimal jaw posi-

Spring 2020 PCSO Bulletin

tions in all three dimensions, and optimal chin
prominence. The term optimal is used to mean
that the positions of the teeth and jaws maximally promote health, function, and appearance
in measurable ways. Having goals is important,
but not particularly useful without the reliable
means by which their presence or absence can be
assessed. This is where landmarks and referents
are critical.
PT: Can you elaborate on landmarks and referents?
WA: A landmark is a point or line that is relatively stationary that can be used to assess the
position of something that you wish to move.
A referent is a point or line representing the
object you intend to move. Without landmarks
and referents that are reliable, effective, and
universal, our abilities to diagnose and classify
are handicapped. Most traditionally used landmarks and reference lines, for example, sella-nasion (landmark) and point A (reference point),
used for the evaluation of the anteroposterior
(AP) position of the maxilla, are unreliable and
ineffective and cannot be applied universally, so
we abandoned their use long ago.
PT: What are a few examples of universal landmarks and referents?
WA: If you are familiar with the six keys to optimal occlusion, tooth angulations and inclinations
are assessed by the relationship between the
facial axis of the clinical crown, which is the referent, and the occlusal plane, which serves as the
landmark. We can consider these to be universal
in the sense that they seem to work equally well
regardless of age, gender, or ethnicity. Another
example has to do with mandibular arch width
and form, for which we use the WALA ridge as
the landmark and the facial axis (FA) points of
the teeth as the referents. All of the treatment
goals have their own unique set of landmarks and
referents, which allows for precise diagnosis and
gives rise to an entirely new system of classifica-

Pacific Coast Society of Orthodontists Bulletin Spring 2020

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2020